High Return to Sport in Patients Over 45 Years of Age Undergoing Osteochondral Allograft Transplantation for Isolated Chondral Defects in the Knee

Cartilage ◽  
2021 ◽  
pp. 194760352110460
Author(s):  
Danielle H. Markus ◽  
Eoghan T. Hurley ◽  
Jonathan D. Haskel ◽  
Amit K. Manjunath ◽  
Kirk A. Campbell ◽  
...  
Keyword(s):  
Visual Analogue Scale ◽  
Analogue Scale ◽  
Return To Sport ◽  
Osteochondral Allograft ◽  
Athletic Activity ◽  
Chondral Defects ◽  
Scale Scores ◽  
Osteochondral Injuries ◽  
The Mean

Objective: The purpose of this study was to evaluate the efficacy of osteochondral allograft (OCA) in patients older than 45 years of age, particularly with respect to return to sport. Design: A retrospective review was performed to evaluate patients greater than 45 who underwent an OCA for a symptomatic osteochondral defect of the knee between June 2011 and January 2019. Results: Overall, there were 18 patients (76% male) that met our inclusion and exclusion criteria. Follow-up was attained in 14 of these patients (78%). The mean age of patients included was 52.6 years (48-57) with a mean of 37 months of follow-up (18-60). Visual Analogue Scale scores decreased significantly from the preoperative baseline to final follow-up (7.7 ± 1.7 vs. 2.0 ± 2.0, P < 0.01). Furthermore, the mean Visual Analogue Scale while playing sport was 3.4 ± 3.2, and the mean Knee Injury and Osteoarthritis Outcome Score was 77.5 ± 12.7 at final follow-up. Overall, 11 patients (78.6%) were able to return to their desired sport. No clinical failures were identified during the follow-up period. Conclusion: In our series of patients 45 years and older who were treated with OCA for focal osteochondral injuries of the knee, we found a significant improvement in clinical outcome scores at a midterm follow-up of 37 months with no revision OCA procedures or conversion to any form of knee arthroplasty. In addition, a high percentage of patients were able to return to their preferred level of athletic activity.

scholarly journals Sporting participation following the operative management of chondral defects of the knee at mid-term follow up: a systematic review and meta-analysis

2020 ◽  
Vol 7 (1) ◽  
Author(s):  
P. G. Robinson ◽  
T. Williamson ◽  
I. R. Murray ◽  
K. Al-Hourani ◽  
T. O. White
Keyword(s):  
Systematic Review ◽  
Autologous Chondrocyte Implantation ◽  
Platelet Rich Plasma ◽  
Meta Analysis ◽  
Osteochondral Allograft ◽  
Chondral Defects ◽  
Chondrocyte Implantation ◽  
The Mean ◽  
Autologous Chondrocyte

Abstract Purpose The purpose of this study was to perform a systematic review of the reparticipation in sport at mid-term follow up in athletes who underwent biologic treatment of chondral defects in the knee and compare the rates amongst different biologic procedures. Methods A search of PubMed/Medline and Embase was performed in May 2020 in keeping with Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. The criteria for inclusion were observational, published research articles studying the outcomes and rates of participation in sport following biologic treatments of the knee with a minimum mean/median follow up of 5 years. Interventions included microfracture, osteochondral autograft transfer (OAT), autologous chondrocyte implantation (ACI), matrix-induced autologous chondrocyte implantation (MACI), osteochondral allograft, or platelet rich plasma (PRP) and peripheral blood stem cells (PBSC). A random effects model of head-to-head evidence was used to determine rates of sporting participation following each intervention. Results There were twenty-nine studies which met the inclusion criteria with a total of 1276 patients (67% male, 33% female). The mean age was 32.8 years (13–69, SD 5.7) and the mean follow up was 89 months (SD 42.4). The number of studies reporting OAT was 8 (27.6%), ACI was 6 (20.7%), MACI was 7 (24.1%), microfracture was 5 (17.2%), osteochondral allograft was 4 (13.8%), and one study (3.4%) reported on PRP and PBSC. The overall return to any level of sport was 80%, with 58.6% returning to preinjury levels. PRP and PBSC (100%) and OAT (84.4%) had the highest rates of sporting participation, followed by allograft (83.9%) and ACI (80.7%). The lowest rates of participation were seen following MACI (74%) and microfracture (64.2%). Conclusions High rates of re-participation in sport are sustained for at least 5 years following biologic intervention for chondral injuries in the knee. Where possible, OAT should be considered as the treatment of choice when prolonged participation in sport is a priority for patients. However, MACI may achieve the highest probability of returning to the same pre-injury sporting level. Level of evidence IV

Syndactyly release: a comparison of skin graft versus graftless techniques in the same patient

2019 ◽  
Vol 44 (8) ◽  
pp. 845-849 ◽  
Author(s):  
Angela A. Wang ◽  
Douglas T. Hutchinson
Keyword(s):  
Visual Analogue Scale ◽  
Skin Graft ◽  
Analogue Scale ◽  
Contralateral Side ◽  
Level Of Evidence ◽  
Tourniquet Time ◽  
The Mean ◽  
Scar Score

Syndactyly release may be done by skin graft or graftless techniques. We prospectively examined bilateral syndactyly releases in the same patient at one operation. The grafted side was randomized and the contralateral side was done graftless. Fourteen patients had surgery at a mean age of 27 months (range 7–166). The mean follow-up was 52 months (range 6–111). The mean tourniquet time was 97 minutes (range 66–135) for graft and 84 minutes (55–120) for graftless. The mean finger abduction was 57° (32°–80°) for graft and 54° (38°–80°) for graftless. The mean web creep score was 1.2 (0–3) for graft and 2.1 (0–3) for graftless. The mean scar score was 1.9 (1–3) bilaterally. The mean parents’ visual analogue scale for graft cosmesis was 7.1 (5–9) and 6.2 (4.3–8) for graftless. The surgeon’s visual analogue scale for graft was 7.9 (6.4–9.5) and 6.2 (4–8.7) for graftless. The therapist’s visual analogue scale was 7.9 (6.5–10) and 6.4 (4.7–8) for graftless. Although there is a longer tourniquet time with grafting, there may be advantages in appearance and web creep. Level of evidence: II

Efficacy of HA Block Kyphoplasty for Old Osteoporotic Spine Fractures

2006 ◽  
Vol 309-311 ◽  
pp. 1371-1374
Author(s):  
Taichi Nishimura ◽  
Hiromi Matsuzaki ◽  
Akihiro Okawa ◽  
Masashi Oshima
Keyword(s):  
Visual Analogue Scale ◽  
Vertebral Fractures ◽  
Neurological Disorder ◽  
Analogue Scale ◽  
Final Evaluation ◽  
Spine Fractures ◽  
Correction Loss ◽  
Pulmonary Infarction ◽  
The Mean

We have successfully treated osteoporotic spine fractures for about three years, by using transpedicular kyphoplasty with hydroxyapatite blocks (HA Block: PENTAX) (refer with: Fig. 1), The 13 patients, four men and nine women, ranged from 61 to 86 years in age (mean, 73 years). The mean Visual Analogue Scale (VAS) was 8.5 points before operation, improved to 2.7 points on the next day of operation, and improved significantly to 1.8 points at the final evaluation. The mean deformity rate (Anterior height / Posterior height x 100) was 66.3% before operation, but improved to 91.7% immediately after operation. At the time of follow-up, this rate was 78.6%, indicating that the correction loss was 13.1%. This procedure caused none of serious complications such as neurological disorder and pulmonary infarction. Kyphoplasty with HA blocks may be safe and effective in the treatment of chronic vertebral fractures.

Elektra prosthesis for trapeziometacarpal osteoarthritis: a follow-up of 39 consecutive cases

2012 ◽  
Vol 37 (7) ◽  
pp. 605-609 ◽  
Author(s):  
A. Klahn ◽  
M. Nygaard ◽  
R. Gvozdenovic ◽  
M. E. H. Boeckstyns
Keyword(s):  
Rheumatoid Arthritis ◽  
Visual Analogue Scale ◽  
Analogue Scale ◽  
Revision Rate ◽  
Gradual Increase ◽  
Biomechanical Properties ◽  
Fast Recovery ◽  
Trapeziometacarpal Osteoarthritis ◽  
The Mean

We present a prospective follow-up of 39 Elektra prostheses in 37 patients (32 women and five men), with a mean age of 56.5 (range 46–71) years; 34 patients had osteoarthritis and three had rheumatoid arthritis. Patients were followed using clinical examination, including measurement of pain on a visual analogue scale, mobility, and strength, after 6, 12, 26, and 52 weeks, and annually thereafter. Radiological examination was done preoperatively and after 6, 26, and 52 weeks, and annually thereafter. The mean follow-up time was 48 (range 3–91) months. Although we observed a fast recovery, including maintenance of mobility and a gradual increase in grip strength, there was a revision rate of 7/38 (24%) after 36 months, increasing to 17/38 (44%) after 72 months. The main reason for revision was loosening of the trapezial component, and biomechanical properties of the trapezial fixation may be the key problem in treating trapeziometacarpal osteoarthritis using a total prosthesis.

The Early Results of the Brunelli Procedure for Trapeziometacarpal Instability

1998 ◽  
Vol 23 (6) ◽  
pp. 758-761 ◽  
Author(s):  
S. N. J. ROBERTS ◽  
J. N. BROWN ◽  
M. G. HAYES ◽  
A. SAIES
Keyword(s):  
Visual Analogue Scale ◽  
Analogue Scale ◽  
Joint Surface ◽  
Carpometacarpal Joint ◽  
Trapeziometacarpal Joint ◽  
Independent Observer ◽  
Abductor Pollicis Longus ◽  
Early Results ◽  
The Mean

We report the results of Brunelli’s abductor pollicis longus transfer for symptomatic instability of the trapeziometacarpal joint in 15 hands (14 patients) at a mean follow-up of 21 months. Patients were assessed subjectively, and objectively by an independent observer. All but one of the patients were very satisfied with the result of the operation, including the six patients who had significant degeneration of the carpometacarpal joint surface preoperatively. Four patients said they had no pain and the mean pain score overall on a visual analogue scale was 1.2 (out of a maximum of 10). Overall the outcome was rated good or excellent in 11 of the 15 thumbs.

A Comparative Analysis of the Results of Vertebroplasty and Kyphoplasty in Osteoporotic Vertebral Compression Fractures

2010 ◽  
Vol 67 (3) ◽  
pp. ons171-ons188 ◽  
Author(s):  
Krishna Kumar ◽  
Rita Nguyen ◽  
Sharon Bishop
Keyword(s):  
Visual Analogue Scale ◽  
Health Survey ◽  
Oswestry Disability Index ◽  
Analogue Scale ◽  
Short Form ◽  
Vertebral Compression Fractures ◽  
Short Form 36 ◽  
Scale Scores ◽  
Euroqol 5D

Abstract BACKGROUND: The most common complication of osteoporosis is vertebral fractures, which occur more frequently than all other fractures (hip, wrist, and ankle). OBJECTIVE: To prospectively analyze vertebroplasty compared with kyphoplasty for the treatment of osteoporotic vertebral compression fractures using improvement in pain, functional capacity, and quality of life as outcome measures. METHODS: The study population included 28 patients in the vertebroplasty group and 24 patients in the kyphoplasty group. The mean follow-up period was 42.2 weeks and 42.3 weeks in the vertebroplasty and kyphoplasty groups, respectively. Outcomes were measured pre- and postoperatively using the visual analogue scale, the Oswestry Disability Index, the EuroQol-5D questionnaire, and the Short-Form 36 Health Survey. RESULTS: In the vertebroplasty group, visual analogue scale scores improved from a mean of 8.0 cm to 5.5 cm at last follow-up (P = .001). Preoperatively, the Oswestry Disability Index was 57.6, which improved to 38.4 (P = .006). The EuroQol-5D score preoperatively was 0.157 and improved to 0.504 (P = .001). The Short-Form 36 Health Survey showed greatest improvement in the areas of physical health, role physical, body pain, and vitality. In the kyphoplasty group, visual analogue scale scores improved from a mean of 7.5 cm preoperatively to 2.5 cm postoperatively (P = .000001). The mean Oswestry Disability Index preoperatively was 50.7 and improved to 28.8 (P = .002). The EuroQol-5D score improved from a mean of 0.234 preoperatively to 0.749 (P = .00004). The Short-Form 36 Health Survey showed greatest improvement in the areas of physical health, physical functioning, role physical, body pain, and social functioning. CONCLUSION: Both vertebroplasty and kyphoplasty are effective at improving pain, functional disability, and quality of life; however, kyphoplasty provides better results, which are maintained over long-term follow-up.

Clinical Outcomes and Failure Rates of Osteochondral Allograft Transplantation in the Knee: A Systematic Review

2017 ◽  
Vol 46 (14) ◽  
pp. 3541-3549 ◽  
Author(s):  
Filippo Familiari ◽  
Mark E. Cinque ◽  
Jorge Chahla ◽  
Jonathan A. Godin ◽  
Morten Lykke Olesen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Survival Rate ◽  
Clinical Outcomes ◽  
Survival Rates ◽  
Osteochondral Allograft ◽  
Failure Rates ◽  
Weighted Mean ◽  
Chondral Defects ◽  
The Mean

Background: Cartilage lesions are a significant cause of morbidity and impaired knee function; however, cartilage repair procedures have failed to reproduce native cartilage to date. Thus, osteochondral allograft (OCA) transplantation represents a 1-step procedure to repair large chondral defects without the donor site morbidity of osteochondral autograft transplantation. Purpose: To perform a systematic review of clinical outcomes and failure rates after OCA transplantation in the knee at a minimum mean 2 years’ follow-up. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of the literature regarding the existing evidence for clinical outcomes and failure rates of OCA transplantation in the knee joint was performed using the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed, and MEDLINE from studies published between 1980 and 2017. Inclusion criteria were as follows: clinical outcomes and failure rates of OCAs for the treatment of chondral defects in the knee joint, English language, mean follow-up of 2 years and minimum follow-up of 18 months, minimum study size of 20 patients, and human studies. The methodological quality of each study was assessed using a modified version of the Coleman methodology score. Results: The systematic search identified 19 studies with a total of 1036 patients. The mean 5-year survival rate across the studies included in this review was 86.7% (range, 64.1%-100.0%), while the mean 10-year survival rate was 78.7% (range, 39.0%-93.0%). The mean survival rate was 72.8% at 15 years (range, 55.8%-84.0%) and 67.5% at 20 years (range, 66.0%-69.0%). The weighted mean patient age was 31.5 years (range, 10-82 years), and the weighted mean follow-up was 8.7 years (range, 2-32 years). The following outcome measures showed significant improvement from preoperatively to postoperatively: d’Aubigné-Postel, International Knee Documentation Committee, Knee Society function, and Lysholm scores. The weighted mean reoperation rate was 30.2% (range, 0%-63%). The weighted mean failure rate was 18.2% (range, 0%-31%). Of note, revision cases, patellar lesions, and bipolar lesions demonstrated worse survival rates. Conclusion: Improved patient-reported outcomes can be expected after OCA transplantation, with a survival rate of 78.7% at 10 years. Revision cases, patellar lesions, and bipolar lesions were associated with worse survival rates; therefore, utilization of the most appropriate index cartilage restoration procedure and proper patient selection are key to improving results.

scholarly journals Laparoendoscopic Single-Site Hysterectomy: A Single Surgeon Experience in a Tertiary Hospital

2018 ◽  
pp. 1
Author(s):  
Gokhan Demirayak ◽  
Onur Guralp ◽  
Mustafa Yildiz ◽  
Cihan Comba ◽  
Veli Mihmanli ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Visual Analogue Scale ◽  
Analogue Scale ◽  
Single Site ◽  
Total Hysterectomy ◽  
Laparoendoscopic Single Site ◽  
Estimated Blood Loss ◽  
Port Site Hernia ◽  
Scale Scores ◽  
The Mean

<p><strong>Objective:</strong> To evaluate the clinical and surgical outcomes of the total hysterectomy cases performed with the laparoendoscopic single site surgery.</p><p><strong>Study Design:</strong> A total of 24 women who underwent total hysterectomy by the laparoendoscopic single site technique due to benign gynecological disorders were retrospectively evaluated. The duration of the operation, estimated blood loss, weight of the uterus, intra- and postoperative complications, pre- and postoperative day 1 hemoglobin and hematocrit levels, postoperative 6- and 24-hour visual analogue scale scores, duration of hospital stay, and postoperative complications were evaluated.</p><p><strong>Results:</strong> The mean total operation time was 112.1±24 minutes. The average time between the umbilical incision and starting the hysterectomy was 10±2.1 minutes. Estimated blood loss was 50±25 ml. The average duration of the hospital stay was 1.5±0.4 days. The mean uterus weight was 135 g. The mean difference between the pre- and postoperative hemoglobin values was 1.1 g/dl. The mean visual analogue scale scores were 4.1 (0-7) and 1.9 (0-4) in 6- and 24-hour postoperative periods. None of the women had an intraoperative complication. One patient (4.2%) had a port site hernia 6 months after the operation.</p><p><strong>Conclusion:</strong> The total hysterectomy with laparoendoscopic single site technique is a reasonable method in selected patients with similar safety and feasibility, especially for women who prefer a single incision in umbilicus. The patient should be informed before the operation about potential complications such as a port-site hernia.</p>

Ten year follow-up of pyrocarbon implants for proximal interphalangeal joint replacement

2014 ◽  
Vol 39 (6) ◽  
pp. 582-586 ◽  
Author(s):  
L. Reissner ◽  
S. Schindele ◽  
S. Hensler ◽  
M. Marks ◽  
D. B. Herren
Keyword(s):  
Visual Analogue Scale ◽  
Migration Rate ◽  
Analogue Scale ◽  
Clinical Results ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
High Migration Rate ◽  
The Mean ◽  
High Migration

Results of anatomical resurfacing of the proximal interphalangeal joint using pyrocarbon implants showed reasonable clinical results with a high radiographic migration rate. The aim was to investigate the subjective, clinical, and radiographic results 10 years following surgery, and to compare them with our 2-year follow-up data. We re-evaluated 12 patients with 15 proximal interphalangeal implants on average 9.7 years after surgery. Pain significantly improved from 7.6 on a visual analogue scale pre-operatively to 1.4 at 2 years, and to 0.7 at the final follow-up. The mean total range of motion in all replaced joints was 36° pre-operatively and 39° at the 2-year follow-up, but had decreased significantly to 29° at 10 years. We saw one implant migration in addition to the eight migrated implants we already found 2 years after surgery. The moderate clinical results, combined with the high migration rate, mean that we no longer use this kind of implant.

scholarly journals Using arthroscopy combined with fluoroscopic technique for accurate location of the bone tunnel entrance in chronic ankle instability treatment

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Shijun Wei ◽  
Dongsheng Fan ◽  
Fang Han ◽  
Ming Tang ◽  
Changwang Kong ◽  
...  
Keyword(s):  
Visual Analogue Scale ◽  
Analogue Scale ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Bone Tunnel ◽  
Lateral Ligament ◽  
Graft Tension ◽  
The Mean ◽  
Tunnel Entrance

Abstract Background Minimally invasive reconstruction techniques are used for anatomical ligament construction of the lateral collateral ligament complex of the ankle, but the two key elements, the bone tunnel and the appropriate graft tension, for the identification of the anatomic location during the surgery are not clearly stated. Methods The patients with chronic ankle instability who received arthroscopic anatomic lateral ligament complex reconstruction were retrospectively analyzed. The anatomical location of the bone tunnel was performed under arthroscopy combined with fluoroscopy for accurate location of the bone tunnel entrance. The graft tension and routing were controlled under arthroscopic visualization. The clinical outcomes were assessed using the Karlsson-Peterson score, Sefton articular stability scale, and Visual Analogue Scale (VAS). The complications were recorded during the follow-up. Results A total of 18 patients were enrolled in this study. The mean follow-up was 33.33 ± 3.69 (range from 24 to 36) months. No patient had recurrence of ankle instability after the operation. According to the Sefton articular stability scale, 94.5% of the patients had excellent/good function. The mean value of the anterior drawer tests and the talar tilt angle examination were decreased. The mean of the Karlsson-Peterson score and the Visual Analogue Scale(VAS) score were both improved significantly. Conclusions The anatomic reconstruction of the ankle lateral ligament complex to treat chronic ankle instability using the arthroscopy combined with the fluoroscopic technique could improve the clinical functions, satisfaction, and reduced pain of patients.

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